Physician's Stolen Laptop Leads to $1.5 Million Settlement

September 21, 2012 — Stolen or lost laptops accounted for roughly 1 in 5 incidents of footloose patient data reported to the federal government in 2011, according to a recent study by the accounting firm Kaufman Rossin.

If that statistic is not enough to convince out-and-about physicians to lock their laptops in their car trunks, the federal government will get their attention with a regulatory hammer. Just ask a group practice affiliated with the Massachusetts Eye and Ear Infirmary (MEEI), a specialty hospital in Boston.

In February 2010, a member of that group practice, now retired, had his unencrypted laptop stolen while he was lecturing in South Korea. The laptop contained demographic and health information on roughly 3600 patients. When it announced the theft 2 months later, MEEI stated that there was no evidence to suggest that anyone had accessed or misused the data in the computer. In addition to apologizing for the data breach, MEEI said it was encrypting laptops connected to its network and educating its staff about limiting the amount of patient information stored on the devices.

Those changes were not enough for the Department of Health and Human Services (HHS). Its Office for Civil Rights, which enforces the security provisions of the Health Insurance Portability and Accountability Act (HIPAA), investigated the case of the filched laptop. The inquiry indicated that MEEI and its affiliated medical group demonstrated "a long-term, organizational disregard for the requirements of the security rule," such as analyzing the risks associated with mobile electronic devices and taking the necessary precautions, according to HHS.

On September 17, HHS announced that MEEI and an affiliated medical group, Massachusetts Eye and Ear Associates, had agreed to pay the government $1.5 million to settle "potential violations" of HIPAA. The Massachusetts providers also agreed to a corrective action plan to stay out of HIPAA trouble in the future.

The settlement represents neither an admission of liability or wrongdoing by the providers nor a concession by the government that the providers did not violate HIPAA.

In a statement posted on its Web site, MEEI said that it has already implemented many of the requirements of the corrective action plan. It called mobile computer technology "both a boon and bane for healthcare providers," helping them work on the run, but also giving them security headaches. MEEI expressed disappointment at the size of the settlement, "given the lack of patient harm discovered in this investigation" and "especially since the independent specialty hospital's annual revenue is very small compared to other much larger institutions that have received smaller fines."

An MEEI spokesperson told Medscape Medical News that hospital officials declined to say anything about the settlement beyond what was posted on the Web site.

Commentary: While the importance of keeping data safe in our computers is highlighted in this article, I am actually amazed at the amount of fine being charged here. This was a problem limited to a single individual, there was no harm to any patient, and there was no evidence that any such action was attempted by the thief. These kind of fines may have a salutary effect on organizations, but the magnitude would also add to health costs, and appears unreasonable in my opinion.

Management of children who have swallowed button batteries

An excellent article that was very helpful when I was trying to decide about intervening in my staff's 1.5 year child who had consumed a button cell last night. Really useful & practical tips, hope other pediatricians will find it helpful too
Management of Children Who Have Swallowed Button Batteries

A fascinating article in Wall Street Journal - Dirtier Lives May Be Just the Medicine We Need

Your great-grandparents faced infectious diseases that hardly threaten you today: tuberculosis, polio, cholera, malaria, yellow fever, measles, mumps, rubella, smallpox, typhoid, typhus, tapeworm, hookworm…. But there's also a long list of modern illnesses that your great-grandparents barely knew: asthma, eczema, hay fever, food allergies, Crohn's disease, diabetes, multiple sclerosis, rheumatoid arthritis. The coincidence of the rise in these "inflammation" diseases, characterized by an overactive immune system, with the decline of infection is almost certainly not a coincidence.

Natural experiments in recent decades support the idea that while modern hygiene defeats infection, it also promotes allergy and autoimmunity. Finns isolated in an impoverished Soviet province had more parasites and fewer allergies than Finns in Finland. Swedes in clean Stockholm had three times as much asthma as Estonians in smoky Estonia. Ethiopians and Gambians got allergies when they lost their intestinal worms. Growing up on a farm greatly cuts allergy risk.In a remarkable new book, "An Epidemic of Absence," Moises Velasquez-Manoff draws together hundreds of such studies to craft a powerful narrative carrying a fascinating argument. Infection with parasites prevents or ameliorates many diseases of inflammation. The author briefly cured his own hay fever and eczema by infecting himself with hookworms—before concluding that the price in terms of diarrhea and headaches was too high.

I've touched on the "hygiene hypothesis" in these pages before. In its cartoon form the argument—that in a clean world our immune system gets bored and turns on itself or on harmless pollen—isn't very convincing. But Mr. Velasquez-Manoff makes a far subtler, more persuasive case. Parasites have evolved to damp our immune responses so that they can stay in our bodies. Our immune system evolved to expect parasites to damp it. So in a world with no parasites, it behaves like a person leaning into the wind when it drops: The system falls over.

Moreover, just as brains outsource much of their development to the outside world—the visual system is refined by visual input, the language system can only develop in a language-using society—so the immune system seems to have happily outsourced much of its regulation to friendly microbes. Without them, the immune system becomes unbalanced.

Timing seems to be key. If you pick up Epstein-Barr virus and Helicobacter early in life from your mother pre-chewing your food, they seem to help protect you against inflammation diseases. Catch them later and they may cause multiple sclerosis and stomach cancer, respectively.

One of Mr. Velasquez-Manoff's most surprising chapters is on autism, a disorder that almost exactly parallels asthma in its recent rise among affluent, urban, mainly male, disproportionately firstborn people. Better diagnosis explains perhaps half the rise, but the brains of people with autism are often inflamed, and there's anecdotal evidence that infection with worms or viruses can tame autistic symptoms, at least temporarily.

There's also a link between inflammation during pregnancy, caused by allergy or autoimmune disease (or chronic, low-grade infection), and autism in the child. Acute infections during pregnancy, on the other hand, correlate with schizophrenic symptoms, which may be why schizophrenia is growing rarer while autism grows more common.

Mr. Velasquez-Manoff even raises the possibility that heart disease, diabetes, obesity and even some kinds of cancer and depression may owe something to an unbalanced immune system caused by an impoverished microbial ecosystem. Few doctors are yet willing to recommend deliberate infection with parasites to regulate the immune system, especially not for pregnant women. But that we should all be rearing our kids to be a little bit dirtier—in a healthy, rural, probiotic sort of way—looks more and more like good advice.

Write to Matt Ridley at matt.ridley@wsj.com

A version of this article appeared September 8, 2012, on page C4 in the U.S. edition of The Wall Street Journal, with the headline: Dirtier Lives May Be Just the Medicine We Need.

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Commentary: Another fascinating article that explores the possible link between diseases, auto-immunity, and exposure to allergens at an early age. Given that a westernized life-style in India has lead to many of these diseases coming up in India too, the theories suggested may have some merit and need further research. I would like to read the book  "An Epidemic of Absence," Moises Velasquez-Manoff  and try to figure out some of this stuff for myself too .

Government to ban over-the-counter sale of 92 antibiotics

NEW DELHI: Over-the-counter sale of around 92 antibiotic and anti-tuberculosis drugs will be clamped down in India soon.

Drug Controller General of India (DCGI) Dr G N Singh has written to the Union health minister to notify a new schedule H1 in the Drugs and Cosmetics Rules.

Once notified, following clearance from the law ministry, these drugs cannot be sold without prescription. The drugs will also have to carry a prominent label in red colour on the left corner with the following warning: "It is dangerous to take this prescription except in accordance with medical advice and not to be sold by retail without the prescription of the registered medical practitioner."

Dr Singh said important drugs that Indians are becoming resistant to or can become resistant to are being put under schedule H1.

He added, "These drugs will only be sold against a prescription that the chemist will have to retain. The label of these drugs will have to carry a special warning. I am instructing the state drug controller generals to be ready to conduct surprise check on compliance of retailers once H1 is notified." A Union health ministry official said, "The draft rules to amend the Drugs and Cosmetic Rules were earlier published. We will look at the public feedbacks as soon as the monsoon session in Parliament is over. We intend to notify H1 after the law ministry clears it."

Resistance to antibiotics is becoming a serious threat for India because of popular habit to pop pills at will. Even the World Health Organization (WHO) recently warned that the world is staring at a post-antibiotic era, when common infections will no longer have a cure.

WHO director general Dr Margaret Chan had said, "The world is on the brink of losing these miracle cures." Even director of Centres for Disease Control Atlanta chief Dr Thomas R Frieden, who was in India, told the TOI that drug resistance due to irrational use of antibiotics will increase in the future.

"It is very important that India came out with a policy to control irrational use of antibiotics. Superbugs like NDM1 and drug resistance are definitely major threats," Dr Frieden had said.

A recent study by the Centre for Disease Dynamics, Economics and Policy, Washington DC, said there has been a six-fold increase in the number of antibiotics being popped by Indians.

This includes the retail sale of Carbapenems — a powerful class IV antibiotics, typically used as a "last resort" to treat serious infections caused by multi-drug resistant, gramnegative pathogens.

The CDDEP study said that retail sale of carbapenems increased six times — from 0.21 units per million in 2005 to 1.23 in 2010 — raising serious fears of resistance to these drugs.

The Centre said that based on pharmaceutical audit data from IMS Health's Multinational Integrated Data Analysis System (MIDAS), the size of the carbapenem retail market in India was $27.4 million (Rs 119.4 crore) in 2010. The drugs to come under H1 includes Moxifloxacin, Meropenem , Imipenem, Ertapenem, Doripenem, Colistin, Linezolid , Cefpirome, Gentamicin, Amikacin, Pencillin, Oxacilin, Zolpidem, Cefalexin, Norfloxacin , Cefaclor, Cefdinir, Tigecycline , Tobramycin, Tramadol and Vancomycin.

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Commentary: This is a very important step to reduce misuse of antibiotics, including resistance, by chemists & well-meaning but ignorant parents. It will also bring us closer to the developed countries, wherein no antibiotics (even topical eye drops!) can be sold over-the counter (OTC).